OMB control number

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CMS-10169)

OMB 0938-1016 · HHS/CMS.

OMB 0938-1016

CMS is seeking approval to reinstate the Information Collection Request (ICR) and to update our burden estimates to Forms A and B in preparation for the next round. CMS will publish a slightly modified version of Form A so that bidders will be better able to identify and understand the new requirement related to bid surety bonds (Section 1847(a)(1)(G) of the Act, added by section 522(a) of the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-10) (MACRA). We have made changes to Form B to remove the expansion plan section and to include the bidding methodology proposed in CMS-1691-P (83 FR 34304).

The latest form for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CMS-10169) expires 2021-12-31 and is listed under ICR 201812-0938-004.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form Form A Business Organization	Form and Instruction
Form Form A Form A: Application for DMEPOS Competitve Bidding Program	Form and Instruction
Form Form B Bid Sheet	Form and Instruction
Form Form B Manufacturer, Model Name, and Number	Form and Instruction
Form Form B Manufacturer	Form and Instruction
Form Form B Create Bid	Form and Instruction
Form Form B Certification	Form and Instruction
Form CMS-10169 Form B _ Bidding Form	Form and Instruction
CMS-10169 - Supporting_Statement_Part_A to OSORA 06.04.26 (2026 version 12) CLEAN final.docx	Supporting Statement A
Form A: Application for DMEPOS Competitve Bidding Program	Form and Instruction
Form A: Application for DMEPOS Competitve Bidding Program	Form and Instruction
Bidding Form (Form B)	Form and Instruction
Bidding Form (Form B)	Form and Instruction
Bidding Form (Form B)	Form and Instruction
Bidding Form (Form B)	Form and Instruction
Bidding Form (Form B)	Form and Instruction
Bidding Form (Form B)	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202512-0938-005	Reinstatement with change of a previously approved collection	2026-06-04
202507-0938-015	Reinstatement with change of a previously approved collection	2025-07-14
201812-0938-004	Reinstatement with change of a previously approved collection	2018-12-06	Approved without change
201807-0938-009	Reinstatement with change of a previously approved collection	2018-07-26	Comment filed on proposed rule
201703-0938-014	Revision of a currently approved collection	2017-03-23	Withdrawn and continue
201701-0938-004	Revision of a currently approved collection	2017-02-08	Improperly submitted and continue
201508-0938-005	No material or nonsubstantive change to a currently approved collection	2015-08-05	Approved without change
201411-0938-001	No material or nonsubstantive change to a currently approved collection	2014-11-03	Approved without change
201407-0938-008	Revision of a currently approved collection	2014-07-08	Approved without change
201305-0938-005	Revision of a currently approved collection	2013-05-10	Approved without change
201207-0938-007	Revision of a currently approved collection	2012-07-31	Approved without change
201111-0938-001	No material or nonsubstantive change to a currently approved collection	2011-11-02	Approved without change
201110-0938-009	No material or nonsubstantive change to a currently approved collection	2011-10-24	Withdrawn and continue
201006-0938-016	Revision of a currently approved collection	2010-06-30	Approved without change
201006-0938-010	No material or nonsubstantive change to a currently approved collection	2010-06-23	Preapproved
200906-0938-011	Revision of a currently approved collection	2009-06-22	Approved without change
200704-0938-009	No material or nonsubstantive change to a currently approved collection	2007-04-25	Approved without change
200701-0938-012	New collection (Request for a new OMB Control Number)	2007-01-12	Approved with change

OMB Details

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C)

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-10169	Quarterly Report	Fillable Printable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.